Medicare Schmedicare, Why Should I Care (Part 2.)

So how do you think you did on the True – False quiz last week? Take a look at the answers below:

TRUE OR FALSE

1. Doctors of Chiropractic can “opt-out” of Medicare. That is, they can sign a form and still treat Medicare patients, but they must agree not to bill Medicare for any of the services.

   False.
   While medical doctors can in fact opt out of Medicare and still see Medicare patients, chiropractors cannot. I have heard of a few who claim to have done so, my suspicion is that they were unaware that chiropractors are not allowed to do so, and they filled out the application, and some untrained employee processed the application and gave them the opt-out status inadvertently. Who knows, it may simply be one of the chiropractic urban legends, but if you happen to have one of those letters, better store it in a safety deposit box somewhere. (And fax me a copy, I’d love to have it for my files. J )

2. It is always good to get an ABN signed at the beginning of care for any Medicare patient. This way, any time you are denied payment for services, your patient has been warned well in advance so they won’t be surprised, and you can still collect from them.
   False.
   Having an ABN signed “in case” you get denied is not proper procedure and could render all of your ABNs useless. The only time you have an ABN signed is if the care that the patient is getting is truly maintenance by Medicare standards OR, you have reached a clearly defined or demonstrable screen from your carrier.
3. If I am billing a CMT with the codes of 98940, 41 or 42 and it is active care, I should append the AT modifier on the CMT.
   This is a little bit of a trick question; the answer is that this is
   True
   so long as it is not maintenance. All active treatment care has the AT modifier appended to the 98940, 41 or 42.
4. The acronym for the Medicare accepted system for documenting subluxation is S.O.A.P.
   False.
   The acronym that Medicare seeks to define medical necessity, is P.A.R.T.. Pain and tenderness. Asymmetry/Misalignment. Range of Motion. Tissue/tone changes. You can use a S.O.A.P. note to list these findings, if you wish, so long as they answer the P.A.R.T. with at least two of the four components, and at least one is A. or R..
5. As a C.A., if I follow instructions that my doctor gave me, or I learned at a publicized Medicare seminar and bill incorrectly for a Medicare patient, I cannot be charged with any crime.
   False.
   Ignorance is no excuse for breaking a law or a rule. C.A.s could be held accountable if they bill Medicare incorrectly, even if they are following the doctor’s orders. ALL C.A.s need to know how to properly bill and to be able to recognize when they are being asked to do anything that is against federal, state or local rules and regulations.
6. Medicare is no longer covering x-rays that are ordered by a medical doctor for a patient to receive care from a chiropractor.
   False!
   Prior to this year, a chiropractor could send a patient to their medical doctor or the E.R. and have x-rays paid for by Medicare. But since Medicare no longer require x-rays as documentation method, they no longer pay for it if a chiropractor or radiologist orders them so that the patient can have chiropractic care.  You can however, send them to their PCP to get x-rays and they can be reimbursed.
7. It is necessary for me to learn my state’s own Medicare rules and regulations since surveys have shown that more than 90% of the time when a Medicare carrier is contacted with a question on a Medicare issue, there is at least one incorrect answer given.
   True!
   Surveys have shown that as much as 93% of the time false information is given when a Medicare carrier employee is consulted about a Medicare issue. SCARY. So once again C.A.s (and Doc.s!) know your stuff or know where to find the right answers!
8. If I don’t want to follow the rules of Medicare, I can choose to be non-par and then I won’t have to worry about denials, documentation etc., and I can still collect from my patients.
   False!
   Being non-par has absolutely NO bearing on whether or not you have to go by the rules! All of the documentation rules still apply to any doc who is adjusting a Medicare patient. Basically, the only thing that changes is the amount you can charge a Medicare patient.

So how did you do? Any surprises? Medicare is one of the more confusing things that we have to deal with in a chiropractic office. Let’s face it, the government rules and regulations…need I say more.

Stay tuned for more to come on the navigating Medicare. If you have a question that you would like answered, please send it to practicalca@practicalpracticing.com and check back for the answer in a future edition.

Practically Yours,

the PracticalCA

Medicare Schmedicare, Why Should I Care? (Part 1 of many.)

I have heard from many doctors and their C.A.s that Medicare is one of the most frustrating aspects of running a chiropractic practice. I’ve heard doctors say that this is why they don’t “get involved with Medicare.” Or “I’m going to be non-par next year!” But the truth of the matter is that Medicare is crucial for all D.C.s and their C.A.s to learn and to understand. I will devote considerable time in the upcoming posts to helping to navigate the Medicare “mess.”

First of all, “why should I care?” The reason that all D.C.s need to learn how to be compliant in all aspects of the Medicare program is that many private insurers use Medicare as a model for their policy. If you learn to document in a manner that will fit the Medicare “medical necessity box” then you will be well on your way to having a compliant practice that will pass the test for just about any insurer, your state board, the courts, or if you have the unfortunate experience of being contacted for an audit.

So I will begin by asking some questions and will post the answers in an upcoming post. Please realize that at least SOME of the following statements are not true, so please make sure that you wait for the answers before you take any of this as “Medicare Doctrine.”

TRUE OR FALSE

1. Doctors of Chiropractic can “opt-out” of Medicare. That is, they can sign a form and still treat Medicare patients, but they must agree not to bill Medicare for any of the services.
2. It is always good to get an ABN signed at the beginning of care for any Medicare patient. This way, any time you are denied payment for services, your patient has been warned well in advance so they won’t be surprised, and you can still collect from them.
3. If I am billing a CMT with the codes of 98940, 41 or 42 and it is active care, I should append the AT modifier on the CMT.
4. The acronym for the Medicare accepted system for documenting a subluxation is S.O.A.P.
5. As a C.A., if I follow instructions that my doctor gave me, or I learned at a publicized Medicare seminar and bill incorrectly for a Medicare patient, I cannot be charged with any crime.
6. Medicare is no longer covering x-rays that are ordered by a medical doctor for a patient to receive care from a chiropractor.
7. It is necessary for me to learn my state’s own Medicare rules and regulations since surveys have shown that more than 90% of the time when a Medicare carrier is contacted with a question on a Medicare issue, incorrect answers are given.
8. If I don’t want to follow the rules of Medicare, I can choose to be non-par and then I won’t have to worry about denials, and I can still collect from my patients.

So take a minute and see how you do. We’ll cover these questions as well as many others, in the weeks to come right here at the PracticalCA blog.

If you have a Medicare question, please feel free to submit it to practicalca@practicalpracticing.com and we may just feature it here. J

Practically Yours,

The PracticalCA